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针对患者利益的机器学习和人工智能研究:在透明性、可重复性、伦理和有效性等方面的20个关键问题

英国医学杂志中文版 2020年第9期23卷 522-533页

作者： Sebastian Vollmer Bilal A Mateen Gergo Bohner Franz J Kirdly Rayid Ghani Pall Jonsson Sarah Cumbers Adrian Jonas Katherine S L McAllister Puja Myles David Granger Mark Birse Richard Branson Karel G M Moons Gary S Collins John P A Chris Holmes Harry Hemingwayp 李峰(译) 徐磊(校) 赵邑(校) Alan Turing Institute Kings CrossLondonUK Departments of Mathematics and Statistics University of WarwickCoventryUK Warwick Medical School University of WarwickCoventryUK Kings College Hospital Denmark HillLondonUK Department of Statistical Science University College LondonLondonUK University of Chicago ChicagoILUSA Science Policy and Research National Institute for Health and Care ExcellenceManchesterUK Health and Social Care Directorate National Institute for Health and Care ExcellenceLondonUK data and analytics Group National Institute for Health and Care ExcellenceLondonUK Clinical Practice Research datalink Medicines and Healthcare products Regulatory AgencyLondonUK Medicines and Healthcare products Regulatory Agency LondonUK Julius centre for Health Sciences and Primary Care UMC UtrechtUtrecht UniversityUtrechtNetherlands UK EQUATOR centre Centre for Statistics in MedicineNDORMSUniversity of OxfordOxfordUK Meta-Research Innovation centre at Stanford Stanford UniversityStanfordCAUSA Department of Statistics University of OxfordOxford 0X13LBUK Health data Research UK London University College LondonLondon.UK Institute of Health Informatics University College LondonLondonUK National Institute for Health Research University College London Hospitals Biomedical Research CentreUniversity College LondonLondonUK 深圳智影医疗公司首都医科大学附属北京安贞医院清华大学附属北京清华长庚医院皮肤科

机器学习(ML)、人工智能(AI)和其他现代统计方法正为利用先前尚未开发且极速增长的数据资源提供新的机会,以期让患者获益。尽管目前正在进行许多有前景的研究,特别是在图像方面,但就文献整体而言还缺乏透明度、对可重复性清晰的阐述、... 详细信息

机器学习(ML)、人工智能(AI)和其他现代统计方法正为利用先前尚未开发且极速增长的数据资源提供新的机会,以期让患者获益。尽管目前正在进行许多有前景的研究,特别是在图像方面,但就文献整体而言还缺乏透明度、对可重复性清晰的阐述、对潜在伦理问题的探究,以及对有效性的明确验证。这些问题的存在有许多原因,其中最重要的一点(为此我们提供了初步解决方案)就是当前缺乏针对ML和AI的最佳实践指南。我们认为从事研究的跨学科团队和应用ML/AI影响健康的项目,将因解决有关透明度、可重复性、伦理和有效性(TREE)的一系列问题而受益。这里提出的20个关键问题为研究团队提供了一个研究设计、实施和报告框架;帮助编辑和同行评审专家评估文献的贡献;让患者、临床医生和政策制定者评估新发现可能会给患者带来的获益。

关键词：人工智能研究机器学习同行评审数据资源缺乏透明度可重复性透明性跨学科团队

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Heart rate response and recovery during exercise predict future delirium risk——A prospective cohort study in middle-to older-aged adults

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Journal of Sport and Health Science 2023年第3期12卷 312-323页

作者： Lei Gao Aden Gaba Peng Li Richa Saxena Frank A.J.LScheer Oluwaseun Akeju Martin K.Rutter Kun Hu Department of Anesthesia Critical Care and Pain MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMA 02114USA Medical Biodynamics Program Brigham and Women's HospitalBostonMA 02115USA Division of Sleep Medicine Harvard Medical SchoolBostonMA 02115USA Broad Institute of Massachusetts Institute of Technology and Harvard CambridgeMA 02142USA Center for Genomic Medicine Massachusetts General HospitalBostonMA 02114USA Division of Diabetes Endocrinology and GastroenterologySchool of Medical SciencesFaculty of BiologyMedicine and HealthManchester Academic Health Science CentreUniversity of ManchesterManchester M139PLUK Diabetes Endocrinology and Metabolism CentreManchester University National Health Service Foundation TrustManchester M139WLUK

Background:Delirium is a neurocognitive disorder characterized by an abrupt decline in attention,awareness,and cognition after surgical/illness-induced stressors on the *** is now an increasing focus on how cardiovascular health interacts with neurocognitive disorders given their overlapping risk factors and links to subsequent dementia and *** common indicator for cardiovascular health is the heart rate response/recovery(HRR)to exercise,but how this relates to future delirium is ***:Electrocardiogram data were examined in 38,740 middle-to older-aged UK Biobank participants(mean age=58.1 years,range:40-72 years;47.3%males)who completed a standardized submaximal exercise stress test(15-s baseline,6-min exercise,and 1-min recovery)and required hospitalization during *** HRR index was derived as the product of the heart rate(HR)responses during exercise(peak/resting HRs)and recovery(peak/recovery HRs)and categorized into low/average/high groups as the bottom quartile/middle 2 quartiles/top quartile,*** between 3 HRR groups and new-onset delirium were investigated using Cox proportional hazards models and a2-year landmark analysis to minimize reverse *** factors,lifestyle factors/physical activity,cardiovascular risk,comorbidities,cognition,and maximal workload achieved were included as ***:During a median follow-up period of 11 years,348 participants(9/1000)newly developed *** with the high HRR group(16/1000),the risk for delirium was almost doubled in those with low HRR(hazard ratio=1.90,95%)confidence interval(95%CI):1.30-2.79,p=0.001)and average HRR(hazard ratio=1.54,95%CI:1.07-2.22,p=0.020)).Low HRR was equivalent to being 6 years older,a current smoker,or>3 additional cardiovascular disease *** were robust in sensitivity analysis,but the risk appeared larger in those with better cognition and when only postoperative delirium was considered(n=1

关键词： Brain health Delirium Exercise stress test UK Biobank

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Acceptability,usefulness,and satisfaction with a web-based video-tailored physical activity intervention:The TaylorActive randomized controlled trial

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Journal of Sport and Health Science 2022年第2期11卷 133-144,I0001页

作者： Stephanie Schoeppe Mitch J.Duncan Ronald C.Plotnikoff W.Kerry Mummery Amanda Rebar Stephanie Alley Quyen To Camille E.Short Corneel Vandelanotte Central Queensl and University School of HealthMedical and Applied SciencesAppleton InstitutePhysical Activity Research GroupRockhamptonQLD 4702Australia The University of Newcastle College of HealthMedicineand WellbeingSchool of Medicine&Public HealthNewcastleNSW 2308Australia The University of Newcastle Priority Research Centre for Physical Activity and NutritionNewcastleNSW 2308Australia The University of Newcastle Priority Research Centre for Physical Activity and NutritionCollege of Human and Social FuturesNewcastleNSW 2308Australia The University of Alberta Faculty of KinesiologySport and RecreationEdmontonAB T6G 2R3Canada The University of Melbourne Faculty of MedicineDentistry and Health ScienceMelbourne School of Psychological SciencesMelbourneVIC 3010Australia

Purpose:This study aimed to examine the usage,acceptability,usability,perceived usefulness,and satisfaction of a web-based video-tailored physical activity(PA)intervention(TaylorActive)in ***:In 2013-2014,501 Australian adults aged 18+years were randomized into a video-tailored intervention,text-tailored intervention,or control *** 3 months,the intervention groups received access to 8 sessions of personally tailored PA advice delivered via the TaylorActive *** the delivery method differed between the intervention groups:video-tailored *** analytics and telephone surveys conducted at post intervention(3 months)were used to assess intervention usage,acceptability,usability,perceived usefulness,and *** and qualitative process data were analyzed using descriptive statistics and thematic content ***:Of 501 recruited adults,259 completed the 3-month post-intervention survey(52%retention).Overall,usage of the TaylorActive website with respect to number of website visits,intervention sessions,and action plans completed was modest in both the video-tailored(7.6士7.2 visits,mean±SD)and text-tailored(7.3±5.4 visits)groups with no significant between-group *** majority of participants in all groups used the TaylorActive website less than once in 2 weeks(66.7%video-tailored,62.7%text-tailored,87.5%control;p<0.001).Acceptability was rated mostly high in all groups and in some instances,significantly higher in the intervention groups compared to the control group(p<0.010).Usability was also rated high;mean Systems Usability Scores were 77.3(video-tailored),75.7(text-tailored),and 74.1(control)with no significant between-group *** usefulness of the TaylorActive intervention was low,though mostly rated higher in the intervention groups compared to the control group(p<0.010).Satisfaction with the TaylorActive website was *** in both intervention groups liked i

关键词： Online Physical activity Process evaluation Program Video-based

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Mental health-related healthcare service utilisation and psychotropic drug dispensation trends in British Columbia during COVID-19 pandemic:a population-based study

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General Psychiatry 2023年第1期36卷 50-57页

作者： Moe Zandy Sylvia El Kurdi Hasina Samji Geoff McKee Reka Gustafson Kate Smolina BC centre for Disease Control VancouverBritish ColumbiaCanada Faculty of Health Sciences Simon Fraser UniversityBurnabyBritish ColumbiaCanada School of Population and Public Health The University of British ColumbiaVancouverBritish ColumbiaCanada BC Children's Hospital Research Institute VancouverBritish ColumbiaCanada

Background The impact of the COVID-19 pandemic on the population’s mental health is vital for informing public health policy and ***,information on mental health-related healthcare service utilisation trends beyond the first year of the pandemic is *** We examined mental health-related healthcare service utilisation patterns and psychotropic drug dispensations in British Columbia,Canada,during the COVID-19 pandemic compared with the prepandemic *** We conducted a retrospective population-based secondary analysis using administrative health data to capture outpatient physician visits,emergency department visits,hospital admissions and psychotropic drug *** examined time trends of mental health-related healthcare service utilisation and psychotropic drug dispensations between January to December 2019(prepandemic period)and January 2020 to December 2021(pandemic period).In addition,we calculated age-standardised rates and rate ratios to compare mental health-related healthcare service utilisation before and during the first two years of the COVID-19 pandemic,stratified by year,sex,age and *** By late 2020,except for emergency department visits,utilisation of healthcare services recovered to prepandemic *** 2019 and 2021,the monthly average rate for overall mental health-related outpatient physician visits,emergency department visits and psychotropic drug dispensations increased significantly by 24%,5%and 8%,*** and statistically significant increases were observed among 10–14 year-olds(44%in outpatient physician visits,30%in emergency department visits,55%in hospital admissions and 35%in psychotropic drug dispensations)and 15–19 year-olds(45%in outpatient physician visits,14%in emergency department visits,18%in hospital admissions and 34%in psychotropic drug dispensations).Additionally,these increases were more prominent among females than males,with some variation for specif

关键词： service consequences Canada

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Longitudinal associations of physical activity and pubertal development with academic achievement in adolescents

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Journal of Sport and Health Science 2020年第3期9卷 265-273页

作者： Eero A.Haapala Henna L.Haapala Heidi Syvaoja Tuija H.Tammelin Taija Finni Noona Kiuru Faculty of Sport and Health Sciences University of JyvaskylaFI-40014Finland Department of Physiology Institute of BiomedicineSchool of MedicineUniversity of Eastern FinlandKuopio CampusFI-70211Finland LIKES Research centre for Physical Activity and Health JyvaskylaFI-40700Finland Department of Psychology Faculty of Education and PsychologyUniversity of JyvaskylabJyvaskylaFI-40014Finland

Objective: We sought to investigate the longitudinal associations of moderate-to-vigorous physical activity(MVPA) and pubertal development with academic achievement in ***: A total of 635 adolescents(283 boys, 352 girls) aged 11-13 years participated in the study. MVPA was assessed by the Health Behaviour in School-aged Children study questionnaire, and pubertal development was assessed by the Pubertal Development Scale at beginning of the 6 th grade(baseline) and end of the 7 th grade(follow-up). Grade point average(GPA) at the end of Grades 5 and 7 was computed from data acquired from the school registers. The data were analyzed using linear regression and analyses of ***: In boys, MVPA was positively associated with GPA at baseline after adjustment for age(b = 0.144, 95% confidence interval(CI):0.028-0.260, p = 0.028). In girls, the Pubertal Development Scale was positively associated with GPA at baseline(b = 0.104, 95%CI: -0.004 to0.211, p = 0.058) and follow-up(b = 0.104, 95%CI: -0.002 to 0.211, p = 0.055) after adjustment for age, and these associations strengthened after further adjustment for MVPA(p < 0.05). Adolescents who were inactive at baseline or at baseline and follow-up had lower GPA during followup than their continuously highly active peers(mean difference = -0.301, 95%CI: -0.543 to -0.058, p = 0.009) and all other adolescents(mean difference = -0.247, 95%CI: -0.475 to -0.019, p = 0.029). These differences were greater in girls than in ***: Lower levels of MVPA were associated with lower GPA in boys at baseline. Girls who were continuously inactive had lower GPA over the follow-up period than those who were continuously active. Finally, earlier pubertal development was associated with better academic achievement in girls.

关键词： Adolescents Brain Children cognition Exercise Maturity Physical activity

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Sleep dysfunctions in schizophrenia: A practical review

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Open Journal of Psychiatry 2012年第4期2卷 384-392页

作者： Flavie Waters Dara S. Manoach centre for Clinical Research in Neuropsychiatry Graylands Hospital North Metro Area Mental Health Perth Australia Department of Psychiatry Massachusetts General Hospital Charlestown USA

Objective: Sleep dysfunctions are common in schizophrenia, yet few evidence-based guidelines exist for the detection, diagnosis and management of sleep disturbances in this disorder. This critical review paper sought to increase awareness amongst mental health clinicians of sleep problems in schizophrenia, promote better identification of sleep problems, and help clinicians make more informed decisions about integrated treatment plans. Specifically, we examined the following key questions: 1) Which sleep problems occur in schizophrenia? 2) What evidence exists regarding the impact of poor sleep? 3) What are the underlying mechanisms of sleep problems in schizophrenia? 4) How can this information be used by clinicians to design a more complete treatment plan? data Sources and study selection: We conducted a non-systematic review of studies that have shaped our current understanding of sleep in schizophrenia (n = 65). data sources included PubMed, Medline, and cross-referencing. Results: Sleep disorders are pervasive and broad-ranging in people with schizophrenia, and are associated with substantial burden. An integrated model is proposed whereby a combination of highly interactive factors comprising genetic and neurobiological vulnerabilities, and behavioural and environmental factors, interact to cause sleep abnormalities. However, prospective and rigorous studies of sleep in schizophrenia are lacking. Conclusion: Patients often do not receive optimal care because sleep problems are rarely diagnosed, and treatments plans are incompletely formulated. A better understanding of sleep problems in schizophrenia will lead to increased treatment options, and a more positive clinical outcome.

关键词： Circadian Sleep Wake Medication PSG Spindles cognition OSA

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Association of electrocardiographic markers with myocardial fibrosis as assessed by cardiac magnetic resonance in different clinical settings

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World Journal of Cardiology 2022年第9期14卷 483-495页

作者： George Bazoukis Sebastian Garcia-Zamora GökselÇinier Sharen Lee Enes Elvin Gul JesúsÁlvarez-García Gabi Miana Mertİlker Hayıroğlu Gary Tse Tong Liu Adrian Baranchuk Department of Cardiology Larnaca General HospitalLarnaca 6036Cyprus Department of Basic and Clinical Sciences University of Nicosia Medical SchoolNicosia 2414Cyprus Department of Cardiology Delta ClinicSanta Fe 341Argentina Department of Cardiology Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research CenterIstanbul 34668Turkey Cardiovascular analytics Group Laboratory of Cardiovascular PhysiologyHong Kong 999077China Division of Cardiac Electrophysiology Madinah Cardiac CentreMadinah 42351Saudi Arabia Department of Cardiology Ramon y Cajal University HospitalMadrid 28034Spain Telehealth Center of Hospital das Clínicas Hong Kong 999077China Kent and Medway Medical School CanterburyCanterbury CT27FSUnited Kingdom Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of CardiologySecond Hospital of TianjinTianjin Medical UniversityTianjin 300211China Department of Cardiology The Second Hospital of Tianjin Medical UniversityTianjin 300211China Department of Cardiology Queen's UniversityOntario K7L 3N6Canada

BACKGROUND Cardiac magnetic resonance(CMR)is a unique tool for non-invasive tissue characterization,especially for identifying *** To present the existing data regarding the association of electrocardiographic(ECG)markers with myocardial fibrosis identified by CMR-late gadolinium enhancement(LGE).METHODS A systematic search was performed for identifying the relevant studies in Medline and Cochrane databases through February *** addition,we conducted a relevant search by Reference Citation Analysis(RCA)(https://***).RESULTS A total of 32 studies were *** hypertrophic cardiomyopathy(HCM),fragmented QRS(fQRS)is related to the presence and extent of myocardial *** and abnormal Q waves are associated with LGE in ischemic cardiomyopathy patients,while fQRS has also been related to fibrosis in *** score,abnormal Q waves,and notched QRS have also been associated with *** abnormalities as reflected by increased Tp-Te,negative Twaves,and higher QT dispersion are related to myocardial fibrosis in HCM *** patients with Duchenne muscular dystrophy,a significant correlation between fQRS and the amount of myocardial fibrosis as assessed by LGE-CMR was *** atrial fibrillation patients,advanced inter-atrial block is defined as P-wave duration≥120 ms,and biphasic morphology in inferior leads is related to left atrial *** Myocardial fibrosis,a reliable marker of prognosis in a broad spectrum of cardiovascular diseases,can be easily understood with an easily applicable ***,more data is needed on a specific disease basis to study the association of ECG markers and myocardial fibrosis as depicted by CMR.

关键词： Myocardial fibrosis Late gadolinium enhancement Electrocardiogram Cardiac magnetic resonance

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Thoughts on Design for Intelligent Manufacturing

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Engineering 2019年第4期5卷 609-614页

作者： David W.Rosen The George W.Woodruff School of Mechanical Engineering Georgia Institute of TechnologyAtlantaGA 30332USA Digital Manufacturing and Design centre Singapore University of Technology and DesignSingapore 487372Singapore

*** Given the emergence of intelligent manufacturing capabilities,we may wonder whether design for manufacturing(DFM)practices should be reconceptualized to take advantage of these ***,if so,what should design for intelligent manufacturing(DFIM)be?The integration of cloud computing,data analytics,artificial intelligence(AI),and the Internet of Things(IoT)with advanced manufacturing technologies has enabled the emergence of what has been called new-generation intelligent manufacturing[1].Such new-generation intelligent manufacturing capabilities will enable transformational new products and services with unprecedented levels of quality,responsiveness,and efficiency.

关键词： services artificial enable

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Precision medicine in sepsis and septic shock:From omics to clinical tools

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World Journal of Critical Care Medicine 2022年第1期11卷 1-21页

作者： Juan Carlos Ruiz-Rodriguez Erika P Plata-Menchaca Luis Chiscano-Camón Adolfo Ruiz-Sanmartin Marcos Pérez-Carrasco Clara Palmada Vicent Ribas Mónica Martínez-Gallo Manuel Hernández-González Juan J Gonzalez-Lopez Nieves Larrosa Ricard Ferrer Intensive Care Department Vall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelona 08035Spain Shock Organ Dysfunction and Resuscitation Research GroupVall d’Hebron Institut de Recerca(VHIR)Vall d’Hebron Barcelona Hospital CampusBarcelona 08035Spain Departament de Medicina Universitat Autònoma de BarcelonaBellaterra 08193Spain Department of Intensive Care Hospital Clínic de BarcelonaBarcelona 08036Spain data analytics in Medicine Digital Health UnitEurecatCentre Tecnològic de CatalunyaBarcelona 08005Spain Immunology Division Vall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelona 08035Spain Diagnostic Immunology Research Group Vall d’Hebron Institut de Recerca(VHIR)Vall d’Hebron Barcelona Hospital CampusBarcelona 08035Spain Department of Cell Biology Physiology and ImmunologyUniversitat Autònoma de BarcelonaBellaterra 08193Spain Department of Clinical Microbiology Vall d’Hebron Hospital UniversitariVall d’Hebron Barcelona Hospital CampusBarcelona 08035Spain Department of Microbiology and Genetics Universitat Autònoma de BarcelonaBellaterra 08193Spain

Sepsis is a heterogeneous disease with variable clinical course and several clinical *** it is associated with an increased risk of death,patients with this condition are candidates for receipt of a very well-structured and protocolized *** patients should receive the fundamental pillars of sepsis management,which are infection control,initial resuscitation,and multiorgan ***,specific subgroups of patients may benefit from a personalized approach with interventions targeted towards specific pathophysiological ***,we will review the framework for identifying subpopulations of patients with sepsis,septic shock,and multiorgan dysfunction who may benefit from specific *** of these approaches are still in the early stages of research,while others are already in routine use in clinical practice,but together will help in the effective generation and safe implementation of precision medicine in sepsis.

关键词： Sepsis Septic shock Organ dysfunction Precision medicine Biomarkers Phenotype Endotype

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Accounting for the Effects of Climate Variability in Regional Flood Frequency Estimates in Western Nigeria

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Journal of Water Resource and Protection 2020年第8期12卷 690-713页

作者： Iguniwari Thomas Ekeu-Wei George Alan Blackburn Jason Giovannettone Lancaster Environmental centre Lancaster University Lancaster UK Kawari Technical Services Nigeria Limited Yenagoa Nigeria Dewberry 8401 Arlington Blvd. Fairfax Virginia USA

Extreme flood events are becoming more frequent and intense in recent times, owing to climate change and other anthropogenic factors. Nigeria, the case-study for this research experiences recurrent flooding, with the most disastrous being the 2012 flood event that resulted in unprecedented damage to infrastructure, displacement of people, socio-economic disruption, and loss of lives. To mitigate and minimize the impact of such floods now and in the future, effective planning is required, underpinned by analytics based on reliable data and information. Such data are seldom available in many developing regions, owing to financial, technical, and organizational drawbacks that result in short-length and inadequate historical data that are prone to uncertainties if directly applied for flood frequency estimation. This study applies regional Flood Frequency Analysis (FFA) to curtail deficiencies in historical data, by agglomerating data from various sites with similar hydro-geomorphological characteristics and is governed by a similar probability distribution, differing only by an “index-flood”;as well as accounting for climate variability effect. data from 17 gauging stations within the Ogun-Osun River Basin in Western Nigeria were analysed, resulting in the delineation of 3 sub-regions, of which 2 were homogeneous and 1 heterogeneous. The Generalized Logistic distribution was fitted to the annual maximum flood series for the 2 homogeneous regions to estimate flood magnitudes and the probability of occurrence while accounting for climate variability. The influence of climate variability on flood estimates in the region was linked to the Madden-Julian Oscillation (MJO) climate indices and resulted in increased flood magnitude for regional and direct flood frequency estimates varying from 0% - 35% and demonstrate that multi-decadal changes in atmospheric conditions influence both small and large floods. The results reveal the value of considering climate variability for fl

关键词： Climate Variability Regional Flood Frequency Climate-Indices L-Moment Madden-Julian Oscillation (MJO) Generalised Logistic (GLO) Climate-Indices

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